Table 1.

Simplified distinctions between acute care and chronic care decision‐making

	Acute care decision‐making	Chronic care decision‐making
The clinical circumstance
Case examples	Surgical treatment choices for patients with new diagnosis of breast cancer; leg amputation vs. medical treatment or revascularization in a patient with diabetes and ischaemic limb pain and ulcers	Lifestyle and pharmacological treatment choices for patients with new diagnosis of uncomplicated type 2 diabetes; living with the sequelae of successful cancer treatments
Rhythm (natural history)	Accelerated deterioration (local tumour growth, pain, bleeding, infection) with hyperacute complications (brain metastases and seizures)	Chronic progression (fatigue, pain) interrupted by acute complications (stroke, vision loss, amputation)
Patient's role	Sick role is acceptable over a brief period	Patients may shift the disease to the background to live their lives and shift it to the foreground prompted by symptoms, complications or impending office visits
Decision making
Decision‐making setting	At health care facility	At patient's habitual personal and social space (bathroom, dining room, workplace)
Opportunity to make the decision	One narrow window of opportunity to consider the choices	Multiple windows of opportunity, choices can be revisited often
Decision reversibility	Irreversible choice	Reversible choices
Nature of the choices
Characteristics of treatment	Inflexible, en‐block, or protocolized treatments	Continuously tailored and responsive to disease progression
Specialized knowledge for treatment administration	Highly technical and unfamiliar choices; administration requires special expertise	Familiar choices of apparent low technical complexity (eat less fat; take this pill); administration requires some training
Treatment/monitoring	Intermittent treatment, ongoing monitoring	Ongoing treatment and monitoring
Patient role during treatment administration	Passive (treatment is inflicted on the patient)	Active (patient controls treatment administration)
Role of compliance/ adherence/concordance	Mostly limited to showing up to appointments – most treatments administered by health professionals at facility	Crucial since patients self‐administer treatments and choose their lifestyle
Social impact of treatment	Limited to economic/social burden of caring for patient for a limited time after treatment	Lifestyle intervention impacts the family; ongoing care needed lifelong
Characteristics of the outcomes
Type of outcomes	Dichotomous, discrete Mostly vivid, explicit, urgent	Continuous, progressive Mostly insidious; some less vivid, implicit (atherosclerosis, kidney damage)
Connotation of the outcomes	Frightening, fatal	Less ominous
Timing of outcomes	Short term	Long term
Improvement	Final (resolution of cancer; elimination of ischaemic pain)	Periodic (symptom control for a period)
Cure	Live without the illness	Living acceptably with the illness